Provider Demographics
NPI:1013997741
Name:AKKAD, HAYSAM (MD)
Entity Type:Individual
Prefix:
First Name:HAYSAM
Middle Name:
Last Name:AKKAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 FARNAM ST
Mailing Address - Street 2:#100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2868
Mailing Address - Country:US
Mailing Address - Phone:402-552-2320
Mailing Address - Fax:402-552-2330
Practice Address - Street 1:4239 FARNAM ST
Practice Address - Street 2:#100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2868
Practice Address - Country:US
Practice Address - Phone:402-552-2320
Practice Address - Fax:402-552-2330
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22700207RI0011X
IA35638207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0580456Medicaid
NE47070592313Medicaid
G43343Medicare UPIN
IAI12885Medicare ID - Type Unspecified
NE47070592313Medicaid